1. Access to ARVs in low and middle income countries - Joseph Perriëns Coordinator HIV technology and commodities HIV dept. World Health Organization

2. ARV price transparency 20092010201120122013 DRV (600 mg)NA3833328752155180 DRV (300 mg)580511231013732664 ETV (100 mg)11731178854 439 RAL (400 mg)NA980973883553 Median price (US$ ppy) paid for third-line drugs by LMICs, 2008-2013 Average price (US$ ppy) paid for first line treatment by LMICs, 2004-2013 Median price (US$ ppy) paid for second line treatment regimens by LMICs, 2008-2013 Source: Global Price Reporting Mechanism http://www.who.int/hiv/amds/gprm/en/

3. Using price data… Median price and range (US$ ppy) of first line treatment regimens in LMIC, 2013 Source: Global Price Reporting Mechanism http://www.who.int/hiv/amds/gprm/en/

4. Increasing supply security

5. Stock-outs require action in financing, supply planning and distribution

6. Regulatory approvals: a neglected area % of 139 countries with at least 1 registered supplier of: Adult formulations Paediatric formulations In 2012, WHO launched a collaborative procedure with national regulatory authorities to fast- track registration of prequalified medicines. 19 countries now participate.

7. Progress in intellectual property Geographic scope of voluntary licenses increased, and new drugs were licensed, e.g.: TDF: to 112 countries (Gilead via MPP) ATV: to 110 countries (BMS via MPP) Dolutegravir: to 144 countries (ViiV via MPP) RPV: to 112 countries (J&J, bilaterally) Countries with no access to voluntary licenses negotiated lower prices, and have at times resorted to compulsory licenses Newer drugs like DRV, RAL, EVG, RPV and TAF remain concerns

8. Concentration: a threat for competition and supply security Source: Global Price Reporting Mechanism http://www.who.int/hiv/amds/gprm/en/

9. Acknowledgements Organizations (contributed data) CHAI, CPS/WHO, GFATM, IDA, JSI, MissionPharma, UNICEF, SCMS, SIAPS/MSH, UNAIDS,UNITAID, USAID. Companies (contributed data) Abbvie, Anhui Biochem United Pharm. Co., APIChem Chemical Technology Co. Arch Pharmalabs, Aurobindo Pharma, Aspen Pharmacare, Boehringer Ingelheim, Bristol-Myers-Squibb, CIPLA, Emcure Pharmaceuticals, Gilead Sciences, Glaxo-Smith-Kline, Hoffmann La Roche, Hetero, J&J, Lonzeal Pharmaceuticals, McLeod, Merck Sharp & Dohme, Microlabs, Mylan, Ranbaxy, Shandong Xinhua Pharm. Co., Shanghai Desano Chem. Pharm. Co, Strides Arcolab, Varichem, ViiV. People (helped write) Vincent Habiyambere (WHO), Boniface Dongmo- Nguimfack (WHO), Peter Beyer (WHO), Francis Aboageye-Nyame (SIAPS/MSH), Martin Autun (GFATM), Nathan Ford (WHO), Robert Matiru (UNITAID), David Jamieson (SCMS), Laurence Läser (WHO), Martina Penazzato (WHO), Chris Wright (JSI), Dominque Zwinkels (SCMS), G Hirnschall (WHO), Andrew Ball (WHO), Michel Beusenberg (WHO), Esteban Burone (MPP), Cees De Joncheere (WHO), Meg Doherty (WHO), Jane Galbao (UNITAID), Zafar Mirza (WHO), Taufiqur Rahman (UNITAID), Jaqueline Sawyer (WHO), Marco Vitoria (WHO), Gundo Weiler (WHO), colleagues in WIPO and WTO.